PAPERS OX MEDICINE AXD PUBLIC HEALTH 317 



third year, though this condition may occur in children 

 bom at term. 



A pathological anemia occurring in twins may affect 

 one or both. The hemoglobin is usually Ioav and the re- 

 duction may be observed during the first days of life. 

 Occasionally one or both parents show marked debility 

 or anemia. Charles Herrman states that twins and sin- 

 gle infants born prematurely come into the world with 

 an imperfectly developed blood forming system and, if 

 some injurious external agent affects the infants, this 

 latent inferiority soon manifests itself. He says that 

 some of these infants show their anemia from birth, some 

 not until later. Von Jaksch's pseudo-leukemic anemia 

 may occur in one or both twins. Finkelstein reports twins 

 who developed a clinical type of pseudo-leukeinic anemia 

 after infections. 



Chlorotic anemia has been described from Finkel- 

 stein 's clinic by Kunkel as occurring in prematures and 

 twins. Kunkel 's investigations considered the blood 

 changes in premature and feeble children. Among this 

 group were seven pairs of twins, sixty prematures, seven 

 feeble children. He found that most of them suffered 

 from a chlorotic type of anemia characterized by 

 oligosideremia and slight diminution of the cellular ele- 

 ments of the blood. Spleen and lymph nodes are not en- 

 larged. This form of anemia occurs very early in life. 

 This is particularly true of the prematures, Kunkel 

 gives several instances where the twins were much be- 

 low normal in weight and the anemia continued until one 

 infant was four months old. At that time his hemoglobin 

 was forty-three per cent. TThen the children were taken 

 out of doors, the condition improved, though at the sixth 

 month the hemoglobin content had reached only sixty 

 per cent. Occasionally only one of the infants becomes 

 anemic, though as a rule both are affected, but there may 

 be a difference in degree. Senator reported a case of 

 splenic leukemia which developed in twin sisters of eigh- 

 teen months : both died about the same time. 



Mental Affection*. Mongolian idiocy may occur in one 

 or both twins, though in the majority of the cases only 

 one of the pair is affected. Halbertsma quotes sixteen 



